The senate has released their version of a healthcare reform bill entitled the Better Care Reconciliation Act of 2017. Learn about the major provisions of the proposed legislation below and how they might impact you.

Individual Mandate

Under the Affordable Care Act (Obamacare) all individuals legally residing in the United States are required to get and keep health insurance unless the individual qualifies for an exemption. This requirement is sometimes referred to as the “Individual Mandate.” Anyone that does not comply with this mandate must pay a fee called the Shared Responsibility Payment when he or she completes her tax return each year. This amount is currently around $700 per person or 2.5% of the consumer’s total income.

The BCRA removes the penalty for failing to purchase insurance. If passed no one would have to pay a penalty.

Employer Mandate

Like the Individual Mandate, the Affordable Care Act (Obamacare) also mandated that certain employers provide health insurance to its employees. This is sometimes referred to as the “Employer Mandate.” This mandate requires employers with 50 or more full time equivalent employees to provide health insurance to at least 95% of their full-time employees and families. If employers fail to offer this required coverage, they must also pay a penalty.

The BCRA removes the penalty for employers as well. If passed employers covered by the Employer Mandate would not have to pay a penalty.

Advanced Premium Tax Credits (APTCs)

Under the ACA, many of you who purchase a plan though the marketplace (healthcare.gov) are eligible for a tax credit, called an Advanced Premium Tax Credit. These credits are advanced (or paid) directly to your chosen insurance company each month to lower your premiums. Under current law, APTCs are available to those of you with a household income between 100% and 400% of federal poverty guidelines. The specific amount of the tax credit available to you depends on what percentage of your income you are expected to contribute to the cost of your health insurance. This percentage depends on your income, with lower-income families being expected to contribute less (around 2%) than higher income families (around 10%). Your tax credit is then calculated by finding the difference between what you are expected to pay and what it would cost you to purchase a specific plan, called the benchmark plan, in your area. This benchmark plan is the next to the cheapest silver plan that is available in your area.

For example, let’s say your family of four has an income of around $36,000 a year, or 150% of federal poverty. According to the government, you would be expected to contribute around 4% of your income, or $1,440, to the cost of your health insurance. In your county, let’s say that the second cheapest silver plan has a premium of $797.52 per month, or $9,570 over the entire year. Your tax credit would be the difference between the cost of the plan ($9,570) and the amount you are expected to contribute ($1,440). So you would be entitled to an annual tax credit of $8,130 or $678 per month.

Another example, let's say you are an older couple (both 63 years old) at the same percentage of federal poverty, or $24,360 per year. According to the government, you would be expected to contribute around 4% of your income, or $975, to the cost of your health insurance. In your county, let’s say that the second cheapest silver plan has a premium of $1,926 per month, or $23,124 over the entire year. Your tax credit would be the difference between the cost of the plan ($23,124) and the amount you are expected to contribute ($975). So you would be entitled to an annual tax credit of $22,149 or $1,846 per month.

The BCRA retains Advanced Premium Tax Credits, but changes who is eligible and the amount.

Under the proposed legislation, individuals with annual household incomes between 350% and 400% are no longer eligible for a tax credit. Individuals with annual household incomes below 350% are still eligible for a tax credit. The current legislation calculates the tax credit in much the same way as the ACA with two notable exceptions. First, the BCRA increases the percentage older consumers with more income are expected to contribute to their health insurance costs. Younger lower-income consumers continue to be expected to contribute around 2% of their income, but older higher-income consumers are expected to contribute up to 16.2% of their income. Second, the BCRA changes how the benchmark plan is chosen. Under the BCRA, the benchmark plan will be a less expensive plan with fewer benefits.

Cost Sharing Reductions

Some of you are also eligible for another type of financial assistance called Cost Sharing Reductions. This assistance is paid directly to your chosen insurance company and reduces your out-of-pocket expenses for copays, deductibles, and co-insurance. Under the ACA, Cost Sharing Reductions are available for those earning between 100% and 250% of federal poverty guidelines.

Under the BCRA, Cost Sharing Reductions are funded until 2019 and then repealed.

Guaranteed Issue (Pre-Existing Conditions)

Under the ACA, insurance companies are not allowed to refuse to sell you insurance because of a pre-existing medical condition you may have. Insurance companies must also cover treatment for any pre-existing medical conditions you may have.

The BCRA retains this requirement.

Essential Health Benefits

Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits.

The BCRA retains this requirement. (There is, however, some concern that this could be changed by a program that allows individual states to obtain a waiver from the government.)

Lifetime and Annual Limits

Under the ACA, insurance companies are no allowed to set a dollar limit on what they will spend for your care during the entire time you are enrolled or during the entire year.

The BCRA retains this requirement.

Preventive Services

Under the ACA, plans must cover a specified set of preventive services – like vaccines and screening tests – at no cost to you.

The BCRA retains this requirement.

Premium Rating Classes

Under the ACA, insurance companies can only base the price of plans offered on your age, location, and whether you use tobacco. They are not allowed to base the price on your gender, race, or health status.

The BCRA retains this requirement.

Dependent Coverage

Under the ACA, dependent children can stay on their parent’s health insurance plan until they are 26 years old.

The BCRA retains this requirement.

Medical Loss Ration

Under the ACA, insurance companies are generally required to spend at least 80% of the money they take in from premiums on health care costs. The remaining 20% may be spent on administrative costs and profit. If insurance companies do not spend enough money on health care costs, they are required to issue a rebate check to all those they insure.

The BCRA retains this requirement until 2019, but thereafter this is left to individual states to decide.

Rating Rules for Age Classes

Under the ACA, older adults may be charged no more than three times the premium as younger adults.

The BCRA changes this requirement to allow older adults to be charged no more than five times the premium as younger adults

Metal Tiers

Under the ACA, insurance plans are divided into four major categories depending on what percentage of your total health care costs they will cover. These categories – Bronze, Silver, Gold, and Platinum – are designed to show you how you and your plan share costs. Bronze plans have the lowest monthly premiums, but the highest costs when you need care. Platinum plans have the highest monthly premiums, but have the lowest costs when you need care.

The BCRA retains this requirement.

Medicaid Financing

Medicaid is a public insurance option that until the Affordable Care Act covered five main groups of people: pregnant women, low-income families, disabled individuals, people who need long term care, and children. The program is jointly funded by states and the federal government. In Georgia, the federal government provides about $6.80 for every dollar the state spends on Medicaid. Currently, there is no cap on the amount of money the federal government will match.

The BCRA changes the way Medicaid is funded. Instead of matching the money Georgia spends on Medicaid, the BCRA will pay Georgia a certain amount of money per person that is enrolled in Medicaid. This amount would be initially based on how much Georgia has spent over the past few years and will be increased each year.

Medicaid Expansion

The ACA extended coverage to non disabled low-income individuals. The federal government provides about $8.00 for every dollar a state spends on covering these newly eligible individuals. Like core Medicaid, there is no cap on the amount of money the federal government will match.

The BCRA continues to give states the option to expand Medicaid, but the enhanced reimbursement rate for these individuals will gradually phase out over several years. In 2020, states would be paid a set amount per person enrolled just like the core Medicaid groups above.

Funding Changes

The BCRA defunds the Prevention and Public Health Fund, which provides grants for prevention, wellness, and public health initiatives.

The BCRA freezes funding to Planned Parenthood for one year and prohibits the use of tax credits to purchase health insurance plans that covers certain pregnancy termination services.

The BCRA increases current funding or creates the following:

Establishes the State Stability and Innovation Program. This program provides short term financial assistance to health insurers to stabilize the insurance market. ($50 billion over four years) It also provides long term financial assistance to be used by states to provide financial assistance to hi-risk consumers, stabilize and reduce individual market insurance premiums, promote participation in the individual insurance market, promote preventive care, or reduce out-of-pocket costs. ($54 billion from 2019 to 2026)

Increases funding to Community Health Centers

Increases funding to the Medicaid Disproportionate Share Hospital

Repeal of ACA Taxes

The BCRA repeals the following ACA taxes:

Medicare payroll tax on high income employee wages

Tax on tanning beds

Tax on health insurers

Tax on pharmaceutical manufacturers

Tax on medical devices

]]>BlogTue, 27 Jun 2017 19:28:49 -0400American Healthcare Act Has Passed the Househttp://www.insurega.org/index.php/happenings/234-american-healthcare-act-has-passed-the-house
http://www.insurega.org/index.php/happenings/234-american-healthcare-act-has-passed-the-houseThe American Healthcare Act has been approved by the House of Representatives.

Please keep in mind that this bill is not yet law. It would still need to be approved by the United States Senate and signed by the President to become law.

This action also does not repeal the Affordable Care Act, shut down the Insurance Marketplace, or mean that you should not get and maintain health insurance.

Last night two amendments were added to the current version of the American Health Care Act.

The first amendment, offered by Representative Thomas MacArthur (NJ), sets up a state waiver program that would allow individual states to change certain aspects of the Affordable Car Act for the citizens of the state.

The second amendment, offered by Representative Fred Upton (MI) increases funding to the Patient and State Stability Fund for individual in states that take advantage of the waiver process. ]]>BlogThu, 04 May 2017 18:02:02 -0400American Healthcare Act: Update http://www.insurega.org/index.php/happenings/232-american-healthcare-act-update-2
http://www.insurega.org/index.php/happenings/232-american-healthcare-act-update-2

The proposed legislation to modify the Affordable Care Act has been pulled from consideration on the House floor. Based on public statements made by Speaker Ryan, it appears that the House will turn to other business.As always, if there are additional updates we will bring them to you here and on our Facebook feed. ]]>BlogFri, 24 Mar 2017 19:07:30 -0400American Healthcare Act: Updatehttp://www.insurega.org/index.php/happenings/231-american-healthcare-act-update
http://www.insurega.org/index.php/happenings/231-american-healthcare-act-updateAs some of you may know, the scheduled vote in the United States House of Representatives on the American Healthcare Act was delayed by a day. During this time, two more amendment packages have been released that makes changes to the legislative text.
As before one of the amendment packages corrects drafting errors and formatting, while the other makes policy changes. ]]>BlogFri, 24 Mar 2017 19:07:30 -0400Amended American Healthcare Act: What Changed?http://www.insurega.org/index.php/happenings/230-amended-american-healthcare-act-what-changed
http://www.insurega.org/index.php/happenings/230-amended-american-healthcare-act-what-changed
]]>BlogTue, 21 Mar 2017 22:38:57 -0400American Healthcare Act: Funding Changes and Restrictionshttp://www.insurega.org/index.php/happenings/229-american-healthcare-act-funding-changes-and-restrictions
http://www.insurega.org/index.php/happenings/229-american-healthcare-act-funding-changes-and-restrictions
]]>BlogFri, 17 Mar 2017 20:25:38 -0400American Healthcare Act: Medicaid http://www.insurega.org/index.php/happenings/228-american-healthcare-act-medicaid
http://www.insurega.org/index.php/happenings/228-american-healthcare-act-medicaid
]]>BlogFri, 17 Mar 2017 01:32:58 -0400American Healthcare Act: Plan Design and Premiumshttp://www.insurega.org/index.php/happenings/227-american-healthcare-act-plan-design-and-premiums
http://www.insurega.org/index.php/happenings/227-american-healthcare-act-plan-design-and-premiums
]]>BlogWed, 15 Mar 2017 18:35:15 -0400American Healthcare Act: Financial Assistancehttp://www.insurega.org/index.php/happenings/226-american-healthcare-act-financial-assistance
http://www.insurega.org/index.php/happenings/226-american-healthcare-act-financial-assistance]]>BlogWed, 15 Mar 2017 02:08:06 -0400American Healthcare Act: Individual and Employer Mandateshttp://www.insurega.org/index.php/happenings/225-american-healthcare-act-individual-and-employer-mandates
http://www.insurega.org/index.php/happenings/225-american-healthcare-act-individual-and-employer-mandatesRegardless of whether the newly released American Healthcare Act (AHCA) represents a repeal, repeal and replace, or a repair of the Affordable Care Act (Obamacare), most of its provisions can be grouped into one of five major topics. This week on Happenings on the Hill, we will feature an in-depth review of each of these topics and how each may impact Georgians.

Perhaps the most widely reported aspect of the AHCA is that the proposed legislation repeals the penalties for what are called the individual and employer mandates.

Individual Mandate

Under the Affordable Care Act (Obamacare) all individuals legally residing in the United States are required to get and keep health insurance unless the individual qualifies for an exemption. This requirement is sometimes referred to as the “Individual Mandate.” Anyone that does not comply with this mandate must pay a fee called the Shared Responsibility Payment when he or she completes her tax return each year. This amount is currently around $700 per person or 2.5% of the consumer’s total income.

The AHCA removes the penalty for failing to purchase insurance. If passed no one would have to pay a penalty.

Employer Mandate

Like the Individual Mandate, the Affordable Care Act (Obamacare) also mandated that certain employers provide health insurance to its employees. This is sometimes referred to as the “Employer Mandate.” This mandate requires employers with 50 or more full time equivalent employees to provide health insurance to at least 95% of their full-time employees and families. If employers fail to offer this required coverage, they must also pay a penalty.

The AHCA removes the penalty for employers as well. If passed employers covered by the Employer Mandate would not have to pay a penalty.

Check back tomorrow to learn how the AHCA changes the way premium tax credits are calculated and used.

]]>BlogMon, 13 Mar 2017 21:38:20 -0400Other Health Reform Planshttp://www.insurega.org/index.php/happenings/224-other-health-reform-plans
http://www.insurega.org/index.php/happenings/224-other-health-reform-plansYou have no doubt heard that the republican leadership has released draft legislation aimed at repealing and replacing the Affordable Care Act (Obamacare), but what you may not know is that there are several other plans under consideration as well. As we continue to analyze the text of the newest republican plan, we thought you all may be interested in some of the details of these “other” plans.
The chart below shows you how three of the plans stacks up against the Affordable Care Act in ten major areas. First, the “Better Way” framework was released by House Speaker Paul Ryan in 2016 and until now represented the republican consensus. Second, the Empowering Patient’s First Act was introduced by former representative (and current Secretary of Health and Human Services), Dr. Tom Price during the 2015 legislative session. Although this plan is no longer officially under consideration, we included it as it represents the current Secretary’s views on the subject. Third, the “Obamacare Replacement Act” was introduced by Representative Rand Paul earlier this year and is generally thought to represents the more libertarian republican viewpoint.

Affordable Care Act

Better Way (Ryan)

Patient’s First (Price)

Obamacare Replacement (Paul)

Exchanges

Establishes healthcare marketplaces for the purchase of individual insurance; tax credits only provided on exchange

Calls for marketplaces but does not specify that they will be run by the government; tax credits available regardless of where insurance is purchases; individual and association health pools

Does not directly address; tax credits available regardless of where insurance is purchases; individual and association health pools

Requires insurers to offer coverage regardless of health status for open enrollment period every two years; thereafter, only requires issue if continuous coverage; creates high risk pools

Requires insurers to offer coverage regardless of health status only when consumer has been continuously covered for 18 months

Essential Health Benefits

Requires all plans cover a set of essential health benefits

Repeals ACA essential health benefit standard

Repeals ACA essential health benefit standard

Repeals ACA essential health benefit standard

Rating

Establishes a 3:1 rating rule; rating only for age, location and smoking status

Proposes a 5:1 rating rule; rating not allowed based on health status; does not address other factors

Repeals 3:1 rating rule; rating not allowed based on health status; rating is allowed on other factors; allows for 50% premium surcharge for non-continuous coverage

Repeals 3:1 rating rule; repeals prohibition on rating factors

Annual and Lifetime Limits

Prohibits Annual and Lifetime limits on insurance coverage

Prohibits Lifetime limits; does not address Annual limits

Repeals both Annual and Lifetime limit prohibitions

Repeals both Annual and Lifetime limit prohibitions

Medicaid Expansion

Prompts states to expand Medicaid to all consumers under 138% FPL; provides 90% of costs for newly eligible

Phase down enhanced reimbursement for newly eligible; sets further reimbursement on a per beneficiary amount

Repeals Medicaid expansion

Retains Medicaid expansion

Individual/ Employer Mandate

All individuals must have minimum essential coverage or pay a fine

Repeals requirement

Repeals requirement

Repeals requirement

Tax Credits

Advanced refundable tax credits for those under 400% FPL based on lowest priced silver plan

Advanced refundable tax credits based on consumer’s age

Advanced refundable tax credits based on consumer’s age

Retains ACA tax credits

Cost Sharing Reductions

Reduced co-pay and deductible amounts for those between 100% FPL and 250% FPL

Repeals ACA cost sharing reductions

Repeals ACA cost sharing reductions

Retains ACA cost sharing reductions

]]>BlogThu, 09 Mar 2017 22:15:26 -0500Happenings on the Hillhttp://www.insurega.org/index.php/happenings/223-happenings-on-the-hill
http://www.insurega.org/index.php/happenings/223-happenings-on-the-hillAre you wondering about the future of the Affordable Care Act? Do you find it hard to know what updates to trust? We understand!

Over the past few weeks we have started to receive more and more calls from Georgians who are concerned about the efforts under weigh on Capitol Hill to change the ACA. To keep you up to date, we have spent the past few weeks working with industry experts, health care lawyers, and the Georgia delegation on Capitol Hill to bring you the most accurate, factual, and unbiased information available. As more plans are introduced and those in Congress begin to negotiate with each other, we will continue to bring you these updates.

To that end we invite you to check out our new blog “Happenings on the Hill” to keep up with the latest legislative happenings.

Over the next few weeks we will be sharing details of all the plans currently being considered and discussing how these plans would change the current makeup of the ACA. We welcome dialogue, so feel free to comment on Facebook or below.